New electronic pharmacy systemimproves patient care

Left to Right: Elizabeth Abraham, medication management pharmacist and Natalka Jewusiak, pharmacy services team leader, discuss the new prescription order scanning system at the Trillium Health Centre site with Allan Mills, shared director of pharmacy for The Credit Valley Hospital and Trillium Health Centre.

Medications across all in-patient areas of Trillium Health Centre, are being delivered in less time and with less risk of error, thanks to the implementation of a new, innovative electronic pharmacy system.

The unique system – which was recently installed at the Trillium Health Centre site of the recently merged The Credit Valley Hospital and Trillium Health Centre, one of Ontario’s largest community-based academic health networks – is a document management solution that combines barcode and scanning technology to speed the time it takes to get physician orders into the hands of hospital pharmacists, shortening overall turnaround time for delivery of patient medications by one-third.

“We knew we needed to decrease our turnaround time and we were also looking for ways to improve the entire cycle of getting doctors’ orders to the pharmacy and back out onto the floor,” says Allan Mills, shared director of pharmacy for The Credit Valley Hospital and Trillium Health Centre. Developed by Toronto-based Medirex Systems – a leading health care solutions company – in partnership with Trillium, the electronic pharmacy system is a cost-effective alternative to a full-blown computerized physician order entry (CPOE) system.

Even though Trillium plans to implement CPOE in the future, the pharmacy system is an important first step that will eventually serve as a backup system, he adds. “What we have found is that this is a very efficient way to decrease patient risk while we prepare for CPOE.”

Each day, Trillium Health Centre site’s 35 pharmacists fill roughly 2,200 medication orders. Prior to implementing the new system, orders were handwritten on traditional carbon copy paper sets and either hand-delivered, sent by a pneumatic tube system, or faxed to the pharmacy. Not only were the copies often difficult to read, resulting in calls back to nursing stations for clarification, but the average turnaround time for completing an order was 11 hours and there was no good way to ensure “stat” or urgent orders were always at the top of the list.

Using the new solution, orders are still handwritten by physicians but are now scanned and sent to the pharmacy electronically as portable document format (PDF) files. All 350 of Trillium’s standardized patient order sets (pre-determined courses of therapy based on best practice) have been updated to include barcode technology so that the scanned orders become ‘intelligent documents,’ automatically populating the pharmacy computer screens with patient information as well as information about each individual order set. For example, if a patient is being admitted for orthopedic surgery, a physician will select the pre-orthopedic surgery order set and the barcode will contain all of the medication information specific to that order set.

“Overall, the electronic pharmacy system is expected to shave as much as four hours off of the turnaround time for filling hospital prescriptions, based on the results of a pilot project conducted on Trillium’s orthopaedics unit,” says Barry Weinstein, Chief Operating Officer of Medirex Systems. “Another advantage is the ability to automatically flag stat orders which are sent to the top of the electronic queue as opposed to waiting in a pile at a fax machine,” he says, adding that pharmacists are finding the scanned orders much clearer to read and will therefore be spending less time on clarification.

“It’s our belief that by implementing this system, we’re actually providing better care,” notes Mills. “We’re getting a more accurate copy and that means less room for error. We’re also getting medications back to the patients who need them more quickly.”

After receiving the scanned prescriptions, Trillium pharmacists go through the process of quality assurance, such as checking the dose and looking for possible drug or disease interactions, before filling orders, and then updating the information in the Hospital Information System (HIS). The original orders become a permanent part of the hospital’s electronic patient record, but copies will also be maintained by the system for a period of 30 days where they can easily be accessed.

“We used to have filing cabinets chock full of yellow carbon copies and when we needed to go back and clarify something, we’d have to manually sort through to find the original,” explains Mills. “Now, because Medirex identifies orders by barcoded patient ID, it’s simply a matter of an electronic search and we will be able to access those orders in seconds.”

Trillium Health Centre completed its merger with The Credit Valley Hospital in December. Mills, who has been the shared director for pharmacy for both hospitals since April 2010, looks forward to rolling out the pharmacy solution to Trillium’s Mississauga and West Toronto locations early this year, then at the Credit Valley Hospital site in Mississauga in the spring.

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